title: Feasibility intervention trial of two types of improved cookstoves in three resource-limited settings: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes.
  
  
  METHODS
  We plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138).
  
  
  METHODS
  At baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period.
  
  
  CONCLUSIONS
  Findings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01686867.
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave, Suite 9121, Baltimore, MD 21205, USA. wcheckl1@jhmi.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Klasen
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.forename: Subarna
authors.initials: S
authors.lastname: Khatry
authors.forename: Diana
authors.initials: D
authors.lastname: Menya
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: Caitlin
authors.initials: C
authors.lastname: Kennedy
authors.forename: Robert
authors.initials: R
authors.lastname: Dreibelbis
authors.forename: Neha
authors.initials: N
authors.lastname: Naithani
authors.forename: Sylvester
authors.initials: S
authors.lastname: Kimaiyo
authors.forename: Marilu
authors.initials: M
authors.lastname: Chiang
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Carter
authors.forename: Charles B
authors.initials: CB
authors.lastname: Sherman
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Breysse
authors.forename: William
authors.initials: W
authors.lastname: Checkley
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects*; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D001794:Blood Pressure; D002248:Carbon Monoxide / Q000378:metabolism; D003296:Cooking / Q000295:instrumentation*; D018592:Cross-Over Studies; D003466:Cultural Characteristics; D003906:Developing Countries / Q000191:economics*; D004784:Environmental Monitoring; D004867:Equipment Design; D045853:Exhalation; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume; D007722:Health Knowledge, Attitudes, Practice; D006794:Household Articles; D006798:Housing; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects; D007630:Kenya; D008168:Lung / Q000503:physiopathology; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008875:Middle Aged; D009390:Nepal; D010366:Peak Expiratory Flow Rate; D010568:Peru; D012107:Research Design; D012307:Risk Factors; D012906:Smoke / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D000393:Air Pollutants; D012906:Smoke; D002248:Carbon Monoxide